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Knowing how your child is doing on ART

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HealthWiki > Helping Children Live with HIV > Chapter 11: ART: Medicines for HIV > Knowing how your child is doing on ART

You know ART is working well when your child becomes healthy, stays healthy, and grows. A child who is growing and learning is doing well on ART.

Treatment programs may also use medical tests, usually blood tests, to measure how the child is doing on ART. The CD4 test shows how strong the child’s immune system is by measuring the amount of CD4 cells in her blood. The viral load test measures how much HIV is in the child’s blood. When the amount of virus is low, ART is working well. So you want the CD4 amount to be high or getting higher, and want the viral load to be low or getting lower.

a health worker speaking to a child sitting on her mother's lap.
We have good news with Joy’s CD4 test.
When tests show a caregiver that there is less HIV in the child’s blood, or that her child’s CD4 amount is going up, it can help her understand more about how ART is working.
a woman speaking to a child.
Taking 1 pill is much easier, isn’t it?

Your child’s ART medicine may change Sometimes children have a problem with one drug in their ART combination. If this happens, that drug might be changed to another one, especially if your child has a harmful or uncomfortable side effect that does not go away.

As babies and young children grow, their ART doses change because they are based on the child’s weight. A child’s ART may also change at a certain age because he can take tablets rather than liquid medicine, or the new dose of his ART combination is available in a single pill.

ART medicines also need to be changed if your child’s ART stops working well.

What happens if ART stops working

ART can work for a very long time if taken faithfully and in the right doses. Many children with HIV are growing up healthy and strong because of ART. But sometimes ART stops working as well as it did. The cause of this is usually problems with taking the medicine every day and at the right time.

Missing just a few ART doses in a month allows HIV to change and adapt. When this happens, those ART medicines do not work as well and HIV can multiply again. This is called drug resistance. Drug resistance causes children to become sickly or develop illnesses that are difficult to treat even though they are taking ART. The child’s CD4 or viral load tests will show that drug resistance has developed. Health workers will then try other ART medicines, if they are available.

The first medicines your child takes are sometimes called “first-line medicines,” the first line of defense against HIV. If these medicines stop working, costlier medicines are needed, sometimes called “second-line medicines.” If the new medicines work well, the child will regain her health. It is even more important to give these medicines faithfully every day, because if this second-line ART stops working, there may be no third-line medicines.

ART doses and drug resistance

Drug resistance can also happen when the child’s ART doses are no longer enough for his size. As children grow — which is all the time! — their weight changes and they need more ART. If a child sees a health worker regularly, their dose of ART can be changed when necessary. This will make sure it continues to work and keep them healthy.

This page was updated:27 Nov 2019